Late Transition
- Estrogen levels highly erratic — wild swings cause most vasomotor symptoms
- Progesterone very low
- FSH rising substantially but still fluctuates
- AMH near undetectable
Menstrual Changes
Skipped cycles — one or more gaps of 60+ days
Primary Symptoms
- • Hot flashes — often frequent and severe
- • Night sweats
- • Flooding (very heavy periods)
- • Significant sleep disruption
- • Joint pain and stiffness
- • Palpitations
- • Vaginal dryness onset
Clinical Protocol
- Diagnose perimenopause clinically — do not wait for 12 months amenorrhea
- Discuss HRT options proactively (not as a last resort)
- Assess cardiovascular risk factors — late perimenopause is the critical prevention window
- Investigate flooding to rule out endometrial pathology if needed
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